What Is the Main Idea?

This blog post answers the query that most pregnant women who are tested as SARS-CoV-2-positive have: “Will my baby get the virus from me? Can I breastfeed my newborn?” The free access paper “Perinatal Transmission and Outcome of Neonates Born to SARS-CoV-2-Positive Mothers: The Experience of 2 Highly Endemic Italian Regions”, published in the journal Neonatology, addresses these questions using evidence from 2 hospitals in Italy.

What Else Can You Learn?

The blog post describes if and how the virus is transmitted to the newborn and what precautions need to be taken. Also, the symptoms most mothers and newborns have when they are SARS-CoV-2 positive are addressed here.

COVID-19 and Pregnancy

COVID-19 is the disease caused by the novel coronavirus SARS-CoV-2 that has affected many around the world including causing millions of deaths. From the onset of the COVID-19 pandemic in early 2020, pregnant women have been precautionarily put in the moderate or high-risk category of developing complications due to COVID-19. While they are not at a higher risk of getting infected, the risk of complications post-infection may be higher.

What symptoms do mothers have? Depending on the study, 15–80% of SARS-CoV-2-positive pregnant women were asymptomatic. Among those who had symptoms, the most common symptoms were fever, cough, loss of taste and smell, nausea, and shortness of breath. Less than 5% of pregnant women had to be admitted to the intensive care unit (ICU) due to COVID-19.

What Does This Mean to the Fetus and Newborn Child?

SARS-CoV-2 in Newborns Seems to Be Rare

Vertical transmission occurs if the mother passes on the infection to the baby when it is still in the womb. Since a lot about SARS-CoV-2 was unknown, doctors tested babies soon after they were born for possible transmission. A review from November 2020 stated that 92% of newborns (born to SARS-CoV-2-positive mothers) were SARS-CoV-2-negative. In a more recent article, where the authors followed the course of SARS-CoV-2-positive mothers in 2 hospitals in Italy, they found that in one hospital 100% of children born were negative for the virus while 94% of children were negative in the other hospital. Therefore, the risk of vertical transmission is low. The authors believe it could be that the placenta prevents the virus to transfer from the mother to the fetus. More studies must be conducted to verify this.

A correlation for vertical transmission that was seen was hypothyroidism (i.e., the thyroid gland doesn’t make enough thyroid hormones to meet your body’s needs). 4 out of 6 women who had hypothyroidism seemed to have passed on the virus to the newborn. However, this again needs to be studied further and verified.

What about transmission after birth? When the authors of the Italian study checked the newborns after 1 month, 97% of newborns tested negative for SARS-CoV-2. This again shows that the incidence of newborns getting the virus is low.

Symptoms in Newborns

In general, COVID-19 is less severe in children. However, in a small number of cases multi-inflammatory syndrome and even fatalities have been reported, as was written in a previous blog post. So, what about newborns?

In the study from the 2 Italian hospitals, all the newborns who tested positive for the virus were asymptomatic. In a previous report, for newborns who were symptomatic, the symptoms mostly reported were fever, shortness of breath, and vomiting.

Breastfeeding When SARS-CoV-2-Positive

The other worry for most mothers who have the virus is whether they can breastfeed. Again, evidence from the Italian hospitals showed that after childbirth when rooming in with the baby and breastfeeding, there was no increased risk of transmitting the virus. Even at the one-month review, where 75% of mothers were breastfeeding, the rate of transmission was low.

When testing the breast milk for the virus, the reports mostly found no virus in it. So, the main mode of transmission of the virus to the newborn, if at all, would be through contact and droplet transmission. To avoid this risk, it is best to follow good practices of washing hands and using a surgical mask when breastfeeding.

With evidence from these studies, right after childbirth, rooming-in with the newborn must be considered. It will help promote breastfeeding and mother-child bonding. Breastfeeding has huge benefits including providing nutrition, antibodies, and other anti-inflammatory factors.

In Short

With rare direct transmission of the virus from mother to fetus and with little evidence of the virus in the breast milk, a SARS-CoV-2-positive mother should be encouraged to provide skin-to-skin contact and breastfeed the baby after taking all precautionary measures.

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